Get Fl 749vmpr 2010-2025

The FL 749VMPR is a vital document for requesting medical pre-authorization from Coventry Health Care of Florida. This guide will provide you with clear, step-by-step instructions to accurately complete the form online.

Follow the steps to effectively fill out the FL 749VMPR online

1. Press the ‘Get Form’ button to access the FL 749VMPR and open it in your document editor.
2. Begin by filling out the provider information section. Include the provider's name, address, city, zip code, and phone number.
3. Next, input the patient information. Provide the patient's name, member ID, date of birth, phone number, address, and the date of your request.
4. In the service requested section, indicate the specific service needed by filling in the appropriate fields. Include the diagnosis and relevant CPT and ICD-9 codes, ensuring all required information is accurate and complete.
5. Attach any necessary clinical documents or plans of treatment to support your request. This information is critical for the authorization process.
6. A contact person is needed, so make sure to list their name clearly in the designated space.
7. Review the service provider instructions carefully to ensure compliance and confirm that all fields on the form have been completed.
8. Once all sections are thoroughly filled out, save your changes. You can then download, print, or share the completed form as required.

Complete your pre-authorization request online today to ensure timely processing.